How do doctors diagnose depression?

The most common diagnostic tool used by doctors to help him decide if a patient with symptoms of depression is actually suffering from the full on illness (and not just a passing state of feeling sad that’s caused by a life event) is a questionnaire.

How do doctors diagnose depression? Here are the common tests they use:

Currently the most common ones are:

Hamilton Depression Rating Scale (HAMD)

Montgomery-Asberg Depression Rating Scale (MADRS)

Beck Depression Inventory

Patient Health Questionnaire (PHQ-9)

Your doctor will likely used one of these tests to assess you. Questions are similar in nature for each. They ask you about symptoms your experiencing – such as: Sleep disturbances, issues with fatigue, suicidal thoughts, feeling uninspired or hopeless, loss of motivation, loss of pleasure. They will also ask you questions to help them understand the severity of your symptoms.

Here are some examples of the types of questions you may be asked:

Have you lost interest in activities you used to find pleasurable?

Ae you experiencing changes in appetite such as eating too much or not feeling like you want to eat?

Are you having difficulty concentrating?

Having you been experiencing thoughts of suicide, death, or wanting to die?

In most cases, if you have felt hopeless for a least two weeks or more and it’s so bad it’s affecting your life – you’re having trouble going to work, socializing, enjoying activities you once thought were pleasurable etc. – these are high indications you have depression.

The diagnostic criteria for depression appears in a medical text for mental illness called the DSM-IV. (Read the diagnostic criteria here).

Your doctor will also likely run some basic biological tests to rule out other potential issues that cause depression. The most common ones are the:

Physical exam. Your doctor will likely examine your body to ensure there is nothing notable wrong with your physiology that could be causing depression symptoms.

Blood tests : A blood sample may be taken and a complete blood count (CBC) will be performed. This helps the doctor find out if you have any hormonal issues or a vitamin deficiency.

How doctors “fix depression”: Antidepressants

If your doctor rules out all other medical issues that could be causing your depressed mood and suggests a diagnosis of major depression they’ll likely treat you by prescribing an antidepressant medication. Doctors are trained to fix medical problems and this is how they do cure depression. It’s the only tool available to them, aside from referring you to a different type of specialist.

You need to be aware that the problem with this route is that they may skip identifying other potential causes for your depression. They will treat the symptoms without curing them. So, you need to investigate therapeutic forms of treatment that teach you how to proactively deal with negative and uncomfortable emotions.

What you need to understand about antidepressant medications:

Finding the right antidepressant for you is like finding the perfect wedding dress. You have to “try on” many to find what works for you. This is because the current diagnostic criteria that doctors use is based on asking you a line of questions, ruling out other illnesses with basic physical tests, and then making an educated assumption.

They don’t do a brain scan to see what’s really going on and here’s why:

It would put too much pressure on the medical system to do these tests for the number of people who end up in their office with symptoms of depression. There are too many people that treating everyone would cause a dramatic back up. This would lead to longer treatment wait times, and possibly more deaths. So, prescribing an antidepressant is the fastest way to treat depression.

Even if they could see what brain regions were affected it still wouldn’t tell them anything about how the condition was caused and thus what treatment to use. So, brain scans would help to identify the problem but hast nothing to do with treating it. Therefore, it’s a lot of fuss for no reason.

So, they test you on a medication for 4-6 weeks and if it doesn’t work, they try something else. If you get worse, well, the sad truth is, sometimes that’s part of the process.

As you can see, this is hardly an effective treatment. But for now, it’s all doctors have. A questionnaire, some basic tests and a lot of trial and error with antidepressants.

But, don’t blame the doctor, it’s the system that’s flawed. We don’t know enough. And because we don’t know our treatment options are unfortunately somewhat limited right now. That is why it’s important to do what you can to help speed up your recovery process.